Essen Medical Associates

Compensation

Full Description

Overview Company Overview: At Essen Health Care, we care for that! As the largest privately held multispecialty medical group in the Bronx, we provide high-quality, compassionate, and accessible medical care to some of the most vulnerable and under-served residents of New York State. Guided by a Population Health model of care, Essen has five integrated clinical divisions offering urgent care, primary care, and specialty services, as well as nursing home staffing and care management. Founded in 1999, our over 20-year commitment has fueled an unwavering dedication toward innovating a better healthcare delivery system. Essen has expanded from a single primary care office to an umbrella organization offering specialties from women’s health to endocrinology, from psychiatry to a vast array of other specialties. All clinical services are offered via telehealth or in-person at over 35 medical offices and at home through the Essen House Calls program. Essen House Calls provides in-home primary and specialty care in the New York Metro area. We are looking for the most talented and effective individuals to join our rapidly growing company. From medical providers to administration & operational staff, there is a career here for you. Join our team today! Job Summary Position: Healthcare EDI Business Analyst – 270/271 Eligibility & Benefits Summary: The Healthcare EDI Business Analyst is responsible for analyzing ANSI X12 270/271 eligibility and benefits transactions, defining business and technical requirements, and designing strategies to parse and present coverage, copay, coinsurance, deductible, and out-of-pocket data to end users. This role bridges product, RCM/eligibility operations, and engineering to ensure accurate, compliant, and user-friendly eligibility verification workflows. Responsibilities Owns the end-to-end strategy for eligibility data presentation, including which EB segments to surface, how to rank conflicting benefits, and how to simplify complex benefit structures for front-line users." Defines the canonical internal data model for eligibility and benefit information used across products and workflows. Lead discovery with revenue cycle, registration, and clinical stakeholders to define how eligibility, copay, deductible, coinsurance, and plan limitations should appear in eCares portal and/or PMS/EHR screens, and reports. Analyze 270/271 X12 files (loops, segments, codes) to document detailed parsing logic for EB, DTP, AMT, HSD and related segments covering benefit levels, service types, and financial accumulators. Translate business needs into functional and mapping specifications for engineering or integration teams, including data dictionaries, field-level requirements, and error-handling rules. Define and maintain business rules to normalize and prioritize multiple EB segments (e.g., selecting primary copay/coinsurance for office visits vs. surgery vs. preventive services). Design and document UI/UX guidelines for displaying eligibility data (e.g., base/remaining deductible, OOP, copay by service type) consistent with CAQH CORE 270/271 data content rules. Partner with EDI and infrastructure teams to support connectivity, trading partner onboarding, and monitoring of 270/271 transactions, including handling rejections and AAA error segments. Create and execute test cases for 270/271 flows, including positive/negative scenarios, regression testing, and validation against companion guides and CORE rules. Work with data/BI teams to define and validate downstream use of eligibility data for dashboards and analytics (e.g., eligibility hit rate, verification timeliness, estimated patient responsibility). Document current and future state eligibility workflows, process maps, and standard operating procedures for front-end staff and revenue cycle teams Ensure compliance with HIPAA, payer companion guides, and CAQH CORE operating rules for eligibility and benefits transactions. Provide subject matter expertise and training to product, operations, and support teams on interpreting 270/271 responses and resolving eligibility-related issues. Qualifications Required Qualifications 3–5+ years of experience as an EDI Analyst, Business Analyst, or similar role in healthcare, with hands-on work on ANSI X12 transactions. Strong, demonstrable experience with 270/271 eligibility and benefits transactions, including reading raw X12 files and understanding loops (2000, 2100, 2110) and EB/EQ segments. Solid understanding of health insurance concepts: plan types, covered services, service types, payer types, primary & secondary plans, HMOs, copay, coinsurance, deductibles, OOP maximums, accumulators, and benefit limitations. Experience creating functional specs, mapping documents, and business rules for parsing and integrating EDI data into PMS/EHR, clearinghouse, or custom applications. Proficiency with advanced Excel and familiarity with SQL or similar tools for validating and profiling eligibility data. Knowledge of HIPAA transaction standards and CAQH CORE eligibility & benefits rules. Strong communication skills and ability to translate technical EDI content into clear requirements and user-facing documentation. Preferred Qualifications Experience in provider revenue cycle, registration, scheduling, or prior authorization operations. Prior work with payer or clearinghouse 270/271 companion guides and real-time eligibility APIs. Background working in Agile product teams, writing user stories and acceptance criteria for eligibility features. Exposure to other HIPAA X12 transactions (835, 837, 276/277, 834) to understand end-to-end data flow. Per Hour Rate: $45 - $55 per hour Equal Opportunity Employer ESSEN HEALTH CARE IS PROUD TO BE AN EQUAL OPPORTUNITY EMPLOYER Essen Health care is proud to be an equal opportunity employer, and we seek candidates who desire to work in and serve an ethnically diverse population.